By Meegan Thompson and Kirsten Matthew

Update: National Obesity Crisis Takes More Children HostageFor New York's Kids, a Special Set of Challenges

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As obesity among America's children skyrockets, researchers continue to track its causes and risks at a steady rate, shedding new light on connections between diet and disease. The seriousness of the epidemic has federal officials scrambling to deal with escalating health problems that could top the scales at the $260-billion mark by 2010. Add to the growing list of debilitating and sometimes fatal later-life health problems like diabetes and heart disease; a whole host of cancers. Double the risk among obese and overweight women of having babies with heart abnormalities and multiple birth defects. “Obesity is a continuing trend,” says Dr. Alvin Eden, chairman of the department of pediatrics at Wyckoff Heights Medical Center in Brooklyn. “More and more kids are becoming obese. There are more fat children today. That’s the reality.” The U.S. government estimates that approximately six million American children are overweight enough to endanger their health, with an additional five million who are balancing on the border. There are nearly twice as many overweight children and almost three times as many overweight teens as there were two decades ago, according to the Centers for Disease Control and Prevention. At age 6, an obese child has a 50 percent chance of being obese as an adult; that number increases to 70 percent to 80 percent at age 10. With other risks such as high blood pressure, Type 2 diabetes, gall-bladder disease, heart disease, and osteo arthritis, it is easy to understand why parents should and have become increasingly concerned with preventing and treating childhood obesity. In the latest New York Times/CBS News poll, released in May, two-thirds of the 624 adults polled nationwide agree with experts that overweight children and teens are a major health problem. Sedentary lifestyles, lack of healthy foods served at home, and electronic diversion led the list of childhood obesity's causes given by the public. Preventing a killer from killing Preventing obesity is, like many health problems, a whole lot easier than curing it, experts acknowledge. Former U.S. Surgeon General Dr. Everett Koop once couched the prevention of obesity in these terms: “Except for smoking, obesity is now the number one preventable cause of death in this country.” Quick intervention is imperative once a child begins sliding off the body mass index curve (a weight-to-height ratio), pediatricians urge. “Parents are not concerned enough early enough,” Dr. Eden says. “An early response is crucial. It’s difficult to treat 10- or 12-year-olds.” It’s not impossible, however. “It can be done. We’ve had some successes,” Dr. Eden says. “I once treated a 13-year-old who weighed 250 pounds. With monthly visits, food diaries, and exercise programs, the child lost 100 pounds over a year. The key is to realize that the earlier families get involved, the better.” Twenty-seven percent of Americans blame a less healthy diet at home on the obesity epidemic among children, the recent poll found. Proliferation of fast foods was blamed for weight problems in children by 21 percent of the adults surveyed. “The most important advice I can give parents about their children’s eating habits is to model good eating (and exercise) habits at home,” says registered dietitian Ilene Smith, who has worked with obese children in her private practice in New York. “Teaching children about healthy foods and providing them with healthy snacks and encouraging them to exercise will fall on deaf ears unless they see their parents practicing what they preach.” Some childhood nutrition experts have held that children can be trusted to eat only the amount they need, and are extremely accurate and resourceful at eating the amount they need and growing at the rate nature intended — until grown-ups spoil it. However, new research shows that high stress levels in children can alter that innate tendency. A study of over 4,000 London school children ages 11 to 12, currently under way, has shown that as their stress levels increase, their healthy eating habits decrease. Not only do the stressed children snack more often, they choose more fattening foods and eat more of them. The study will continue for four years, following the same children’s dietary habits until they are 16. For children who are already obese, the emotional burden they face on a daily basis is particularly difficult. “Obese children are under stress,” Dr. Eden says. “It’s tough on self esteem and self confidence. Children are cruel to each other. Psychological problems develop, related to how other people perceive an obese child.” These feelings of stress brought on by obesity may also cause the child to eat more, prompting a dangerous cycle, he says. Children's lack of physical activity becomes national crisis Dr. Lyuba Konopasek, assistant professor of pediatrics at Weill Medical College of Cornell University and mother of two young children, acknowledges that maintaining healthy eating and exercise routines can be more difficult for New York City parents than for their suburban peers. “Parents who live in New York City have special challenges,” Dr. Konopasek says. “Even getting outside is challenging, but just walking is a great way to burn calories.” New York’s oft-small apartments (with no backyards to run around in) and parents’ reliance on strollers for safety, for children who are old enough to walk on their own, contribute to the problem of city kids not getting enough exercise, Dr Konopasek says. “Just like adults, if children eat more and exercise less, they’re going to increase weight,” she says. According to a new opinion survey released by the National Association of Sport and Physical Education (NASPE), three in four parents, or 76 percent, think more school physical education could help control or prevent childhood obesity. For over 50 percent of parents, the lack of physical activity and sedentary activities were chosen as the most important causes for the rise in childhood obesity. "Our children's lack of physical activity is a national crisis," says NASPE president George Graham, Ph.D., a professor at The Pennsylvania State University. "Physically inactive, overweight children grow up to become physically inactive, obese adults." If parents see physical activity as a key toward helping their children do better academically and that physical education could help solve the obesity problem, then families, schools, and communities need to create more opportunities for children to have physical education and be more physically active, Dr. Graham says. The NASPE survey, conducted by the Princeton, N.J.-based Opinion Research Corporation International, also found that most parents (73 percent) think parents and school officials should work together to make decisions about what students eat and drink at school. School-based nutrition programs have been shown to help children maintain a reasonable weight in adolescence; recent studies found that children who participate in the National School Lunch Program consume twice the servings of fruits and vegetables and eat greater amounts of grains and dairy products. Dr. Konopasek is careful to provide her own children with nutritious snacks, such as cut-up apples or other fruit, dry Cheerios, and sometimes pretzels. She discovered, however, that these weren’t the only snacks her kids were eating. “We didn’t have candy in the house,” she says. “But I found out that babysitters were giving it to them. Talk to your babysitters about what they are feeding your kids. It didn’t occur to me.” Children who expect to be fed nutritious, well-balanced meals and snacks are likely to carry these healthy habits with them into adulthood. “Talk to your kids about making healthy choices,” Dr. Konopasek urges. To encourage healthy eating in children, she also suggests the following: Don’t restrict certain foods from your home, but teach your children that eating pizza every day, for example, is not acceptable. And show them that a few cookies in front of cartoons after a particularly difficult day at school will not help them to feel better. As with other habits, your children will follow your example when it comes to eating and exercise. Allow them to help prepare their food. Chase each other in the park. Go on family walks. Your kids will be healthier — and so will you.

Downsizing in a Super-Sized World Teaching your children not to skip breakfast is a time-old example of instilling proper eating habits. Just as the classic phrase, “Eat your fruits and vegetables”, can be heard from generations of grandparents, parents of 2003 need to learn a new phrase: “Mind your portions.” According to a recent study published in The Journal of the American Dietetic Association, portion sizes of foods typically consumed have increased in size during the past 20 years. So much so, those children today are developing chronic health conditions related to excess consumption of calories — chronic health conditions that, in the past, have only been seen in adults. With increasing portion sizes of commonly consumed foods, coupled with a total decrease in physical activity, are we destined to create a generation of fatties? Let’s look at some of the data: The study out of New York University reports that the original Hershey chocolate bar was 0.6oz, with today’s bars ranging in size from 1.6-8.0oz. A hamburger from a fast food restaurant can be anywhere from 1.6—8.0 ounces of beef, depending upon what you order; the actual serving size should be 1.6 oz. (precooked). Fountain soda in 1955 at McDonald’s was 7 fluid oz. Today the child size is 12.0 fluid oz. This leaves the 42 fluid oz. ‘SuperSize’ regular cola for all of the adults who need an extra 410 calories and 113g of sugar added to their daily diet. Forgetting about fast food, let’s look at a breakfast favorite — the bagel. A standard bagel size is 2 ounces, which is equal to 2 slices of bread, or 160 calories. Marketplace bagels are close to 6 ounces, which is equivalent to eating 6 slices of bread, or 480 calories. Want more? Steakhouses are serving up to 24 ounces of beef to one person, which should feed a family of 8, according to the U.S. Department of Agriculture. And how can we forget the All-American Favorite? Pasta. The recommended serving is half-a-cup cooked, where surveyed marketplace portions are almost 3 cups. The question is not whether increased portion sizes are contributing to a fatter nation; to most people the answer is clear. The question at hand is: What will we teach our children who are growing up in a world of portion distortion? First, I would start by learning what a standard portion size looks like (, or by consulting a registered dietitian. Then, I would recommend following some simple rules of weight management: —Don’t clean your plate —Eat out less often —Don’t drink your calories —When in doubt, buy fruit —If there is no fruit, buy vegetables —And of course, when possible, take the stairs. — Kate Samela Kate Samela, M.S., R.D. is a pediatric nutritionist and private nutrition consultant in New York City. She specializes in family weight management, gastroenterology, nutrition support, sports nutrition, and developmental diabilities. She can be reached at:

New Book Offers Eating Options for Kids There’s an obesity crisis in America and no group is as hard hit as kids are. Recent studies show that nearly 8 million children and teens — or about 15 percent — are overweight or obese. Now a breakthrough new book aimed at the growing number of working moms who can’t supervise what their kids eat around the clock will arm families with much of the ammunition they need to successfully beat the munchies and other waistline and health saboteurs. Memphis, Tenn.-based weight loss expert Rallie McAllister, M.D., both a physician and a mother of four, includes some of the answers in THE HEALTHY LUNCHBOX: The Working Mom's Guide to Keeping You and Your Kids Trim (LifeLine Press, $19.95). “The worst thing you can do to help a child lose weight is to put him or her on a diet,” Dr. McAllister says. “For kids, dieting is risky business because their rapidly growing bodies depend on an adequate number of daily calories for proper development and weight-loss diets can also inflict emotional damage that can lead to overeating or bingeing.” There’s a better way, she writes, including getting kids involved in meal planning, shopping and cooking, and hosting an international night once a week, which helps introduce new foods on a regular basis. She also suggests serving water with each meal. “Getting kids used to drinking water helps them meet daily fluid requirements, prevents overeating, and improves their digestion,” she says. Other tips include replacing favorite high-fat, high-calorie foods and snacks with similar, healthier ones. For example, she recommends switching ice cream to frozen yogurt or frozen fruit pops, potato chips to baked chips or whole-grain pretzels, soda to flavored seltzer, and cookies to dried fruit. Regular physical activity is also important to maintaining a healthy weight, Dr. McAllister writes. That’s why, she suggests, parents should “create an after-school job box” — meaning that after school, kids have to pull out a chore, project, or activity and accomplish it before they are allowed to watch TV or play video games. Studies show a direct correlation between the number of daily hours kids engage in these types of sedentary activities and childhood obesity, Dr. McAllister writes. — Denise Mann The Lunchbox Goes Organic In response to a growing problem on the national nutrition front — with fast food replacing real food on kids' lunch trays and parents too time-strapped to prepare a healthy lunch for them — a new pre-packaged lunch for kids, due to hit supermarket shelves by summer's end, will offer organic deli meats for the first time. The Organic Lunchbox, produced by Applegate Farms, proposes to give kids a healthy way to enjoy premium quality natural and organic products. Available in three varieties — organic turkey breast, organic bologna, and pepperoni pizza — the packages will contain less carbohydrates, sugars and saturated fats than other popular kids' meals-to-go. The two meat varieties will also contain organic mozzarella string cheese, organic crackers and organic fruit bears. The company has enlisted the support of a no-nonsense personality-driven team of cartoon lunch boosters, known as the Lunch Crew, to populate the products' packaging. Construction workers Jigsaw Jenny, Bulldozer Bob, Jackhammer Joe, and Rivet Rita, led by team leader Piledriver Pete, will pepper the outside packaging with pithy catch phrases like: "Building lunch is our job. Eating it is yours." Applegate Farms, founded in 1987, does not use artificial ingredients, coloring agents or chemical preservatives in processing. Its livestock are raised on organic feed on small family farms, and are never given antibiotics or growth hormones. The Organic Lunchbox will be available nationally at Whole Foods and other major natural grocers. — K.M. Obese Kids Must Stay Longer in Hospital Obese children have a tougher time recovering from tonsillectomy and adenoidectomy, according to a new study. Researchers at the University of Southwestern studied the charts of 41 overweight or obese children who required tonsillectomy and adenoidectomy because of obstructive symptoms — symptoms such as snoring and sleep apnea, in which patients repeatedly stop breathing during sleep. They divided the kids into three groups — overweight, obese and morbidly obese. The doctors found that children who were morbidly obese needed to stay in the hospital an average of over five days. In fact, only one of the 17 children in this group was able to go home on the same day as the surgery. Obese children needed an average of three days in the hospital. In the overweight group, only three of the eight children needed to be admitted to the hospital at all, and the average hospital stay was less than one day. The researchers also found that the most obese children were also the most likely to need care in the intensive care unit. More than three-quarters of the morbidly obese patients ended up in intensive care (13 of 17 kids), and stayed there an average of over two days. About one quarter of the obese children (the middle group) required ICU stays. In the overweight group, only one child required admission to the ICU, or about 13 percent. These research findings were presented at the May 2003, annual meeting of the American Society of Pediatric Otolaryngology. — Dale Mazer, M.D., M.P.H.